Greater Health Resources Are Used for Direct-to-implant Breast Reconstruction in Women With Higher Body Mass Index

Healthcare resource use associated with breast reconstruction may vary by body mass index (BMI). We hypothesized that obese women undergoing direct-to-implant (DTI) reconstruction used more resources than healthy-weight women.

Using the Premier Healthcare Database, a retrospective cohort study was conducted among women aged 21 and older who had mastectomy and concurrent DTI breast reconstruction from 2012 to 2020. Patients were classified into obese (BMI ≥ 30 kg/m²) and healthy-weight (BMI 20-25 kg/m²) groups. Outcomes, including cost, operating room time, and 12-month breast reconstruction revision rate, were assessed and compared between the study cohorts. The inverse probability of treatment weighting method was used to balance the covariates between the 2 cohorts. Study outcomes were assessed using weighted generalized estimating equation (GEE) models. Subgroup analyses were conducted to compare study outcomes between morbidly obese patients (BMI ≥ 35 kg/m²) and healthy-weight patients.

After applying study criteria and inverse probability treatment weighting, 1150 patients were identified (682 obese patients and 468 healthy-weight patients). Compared with healthy-weight patients, obese patients had significantly higher procedure costs (mean: $26,778.53 [SD: $21,973.63] versus $24,209.93 [SD: $12,16.90], GEE P = 0.03) and significantly longer operating room time (mean: 285.86 [SD: 110.20] versus 248.02 [SD: 89.43] min, GEE P < 0.001). Significant differences in 12-month revisions were observed between morbidly obese patients and healthy-weight patients (22.9% versus 14.5%, GEE P = 0.02).

Among women undergoing immediate DTI breast reconstruction postmastectomy, those who were obese had significantly higher resource use compared with healthy-weight women.